For terminal disinfection of indoor air in venues such as households and isolation wards of medical institutions, one can refer to the “Management Specifications of Air Cleaning Technique in Hospitals” (WS/T 368–2012). Peracetic acid, chlorine dioxide, hydrogen peroxide, and other disinfectants can be selected to disinfect indoor areas (while unoccupied) by ultra-low volume spray.
Contaminants (Blood, Secretions, Vomitus, etc.)
Small amounts of waste can be carefully removed by using disposable absorbent materials (such as gauze or wipes) and dipped in 5,000–10,000 mg/L chlorine-containing disinfectant. Alternatively, disinfecting with wet wipes/dry wipes that are able to achieve high-level disinfection is acceptable.
Large volumes of waste should be completely covered with disinfectant powder or bleach powder containing water-absorbing ingredients or fully covered with disposable water-absorbing materials that can achieve high-level disinfection. A sufficient amount of 5,000–10,000 mg/L chlorine-containing disinfectant (or disinfected dry towels) should be poured on the water-absorbing materials for 30 minutes followed by careful removal of the waste. One should avoid contact with waste during removal. Resulting disinfected waste should be properly disposed of as medical waste.
Patients’ secretions and vomitus should be collected in a specialized container and should be soaked for two hours with 20,000 mg/L chlorine-containing disinfectant using a ratio of 1∶2 for waste to disinfectant.
After removal of waste, surfaces of the contaminated objects should be disinfected. The container containing waste can be soaked with a 5,000 mg/L chlorine-containing disinfectant for 30 minutes before being cleaned.
Feces and Sewage
Independent septic tanks should be disinfected before their materials enter the municipal drainage pipe network; chlorine-containing disinfectant should be added regularly, and chlorine-containing disinfectant should be added into the tank. Initially, the effective chlorine level should be at least 40 mg/L and total residual chlorine should be 10 mg/L after 1.5 hours of disinfection. Disinfected sewage should meet the Discharge standard of water pollutants from medical organizations (GB18466–2005).
In the absence of a separate septic tank, special containers should be used to collect, disinfect, and dispose of feces. Chlorine-containing disinfectant with effective chlorine concentrations of 20,000 mg/L should be used to soak excrement for 2 hours with an excrement to disinfectant ratio of 1∶2. If there is a large amount of diluted excrement, 70%–80% effective chlorine concentration bleaching powder should be applied, and the slurry should be thoroughly mixed for 2 hours with an excrement to disinfectant ratio of 20∶1.
Floors and Walls
If there are visible contaminants, the contaminants should be completely removed before disinfection. When there are no visible contaminants, one can use 1,000 mg/L of chlorine containing disinfectant or 500 mg/L chlorine dioxide to wipe or spray the floors and walls. Floors should be sprayed with disinfectant once from outside to inside with a volume of 100–300 mL/m2. Following indoor disinfection, the floor should be sprayed once more from the inside out. Disinfection time should be no less than 30 minutes.
When there are visible contaminants on the surface of diagnosis and treatment equipment such as bed rails, bedside tables, furniture, door handles, or household items, the contaminants should be completely removed before disinfection. When there are no visible contaminants, 1,000 mg/L of chlorine-containing disinfectant or 500 mg/L of chlorine dioxide can be used for spraying, wiping, and soaking. After 30 minutes of disinfection, surfaces can be wiped clean with water.
Clothing, Bedding and Other Textiles
Aerosols should be avoided during collection, and it is recommended that textiles be centrally incinerated as medical waste. When there are no visible contaminants and if the textiles need to be reused, they can be disinfected with circulating steam or by boiling for 30 minutes. Alternatively, 500 mg/L of chlorine-containing disinfectant can be used to soak contaminated textiles for 30 minutes prior to standard washing. Alternatively, they can be washed in a washing machine in a water-soluble packaging bag, washed, and then disinfected for 30 minutes, with an effective chlorine content maintained at 500 mg/L. Delicate or valuable clothing can be disinfected using ethylene oxide.
Personnel participating in field work should always use proper hand hygiene practices. An effective alcohol or alcohol compound-based hand rub can be used. Hands can also be directly wiped with 75% ethanol solutions. Individuals allergic to alcohol can choose an effective non-alcohol hand antiseptic agent such as quaternary ammonium disinfectant; under special circumstances, a 3% hydrogen peroxide solution disinfectant, 0.5% povidone-iodine, or 0.05% chlorine-containing disinfectant can be used to wipe or soak hands, using an appropriately prolonged disinfection time. One should wash hands with liquid soap and running water before disinfection when there are visible contaminants.
Skin and Mucous Membranes
When skin is contaminated, the contaminants should be removed immediately, and the skin should be wiped for at least 3 minutes with a disposable absorbent material dipped with 0.5% povidone-iodine or hydrogen peroxide and washed with water. Mucous membranes should be washed with a large amount of physiologic saline or rinsed and disinfected with 0.05% povidone-iodine.
Tableware and Drinkware
After tableware or drinkware is cleared of food residue, it should be boiled and disinfected for 30 minutes or immersed in a chlorine-containing disinfectant with an effective chlorine of 500 mg/L and soaked for 30 minutes before being rinsed with water.
Transported and Transferred Tools
The degree of contamination should be evaluated. When there are visible contaminants in trains, cars, or ships, one should first use disposable absorbent materials dipped with 5,000–10,000 mg/L chlorine-containing disinfectant (or by using disinfectant wipes/dry towel that can achieve high-level disinfection) to completely remove the contaminants, followed by spraying or wiping the area with 1,000 mg/L chlorine-containing disinfectant or 500 mg/L chlorine dioxide and wiping with clean water after 30 minutes of disinfection. When disinfecting aircraft cabins, disinfectant types and dosages should be selected in accordance with the relevant regulations of the Civil Aviation Administration of China. Fabrics, cushions, pillows, and sheets are recommended to be collected and managed centrally as medical waste.
Domestic Wastes from Patients
Waste from patients should treated as medical waste.
The disposal of medical waste should follow the requirements of the Medical Waste Management Regulations and the Medical Waste Management Measures of Medical Institutions. Waste should be collected, packed, and sealed through standard use of double-layered yellow medical waste collection bags; standard medical waste disposal procedures are to be followed.
After death of a patient, one should minimize movement and handling of the corpse leaving it to be promptly handled by trained staff under strict protection procedures. Cotton balls or gauze with 3,000–5,000 mg/L chlorine-containing disinfectant or 0.5% peracetic acid should be used to fill the patient’s mouth, nose, ears, anus, trachea opening, and other open channels or wounds. The body should be wrapped with a double-layer cloth soaked with disinfectant, placed in a double-layer body bag, and sent directly by a special vehicle from the civil affairs department to the designated place for cremation as soon as possible.
On-site disinfection work should be conducted in a timely manner by relevant organizations under the guidance of the local disease prevention and control agency or directly by the local disease prevention and control agency responsible for disinfection. Medical institution periodic disinfection and terminal disinfection should be arranged by the medical institutions with technical guidance from the disease control agency. Non-professionals should receive professional training from local disease prevention and control agencies before starting disinfection so that they can adopt correct disinfection methods and have thorough personal protection.